Employment and Support Allowance claim form

Form

Employment and Support Allowance claim form

Use this form to claim Employment and Support Allowance (ESA) if you're eligible. You may be able to apply for Universal Credit.

Published 1 April 2013
Last updated 30 November 2018 — see all updates

From:

Department for Work and Pensions

Applies to:

England, Scotland, and Wales

Documents

ESA claim form you can download, fill in on screen, save – and then print

Ref: ESA1 PDF, 2.47MB, 64 pages

ESA claim form you can print and fill in with a pen

Ref: ESA1-print PDF, 1.69MB, 64 pages

Welsh: Ffurflen hawlio Lwfans Cyflogaeth a Chymorth y gallwch lawrlwytho, llenwi ar y sgrîn, arbed - ac yna argraffu

Ref: ESA1W PDF, 2.53MB, 64 pages

Welsh: Ffurflen hawlio Lwfans Cyflogaeth a Chymorth y gallwch ei hargraffu a'i llenwi gyda beiro

PDF, 1.76MB, 64 pages

This file may not be suitable for users of assistive technology. Request an accessible format.

ESA renewal claim form: Only complete this form if you got ESA in the last 12 weeks: fill in on screen

Ref: ESA1RR PDF, 1.78MB, 28 pages

This file may not be suitable for users of assistive technology. Request an accessible format.

ESA renewal claim form: Only complete this form if you got ESA in the last 12 weeks: print

Ref: ESA1RR - print PDF, 1.59MB, 28 pages

This file may not be suitable for users of assistive technology. Request an accessible format.

Welsh: Ffurflen hawlio adnewyddu Lwfans Cyflogaeth a Chymorth: Dylech dim ond llenwi’r ffurflen hon os cawsoch Lwfans Cyflogaeth a Chymorth yn ystod y 12 wythnos diwethaf: llenwch ar y sgrin

Ref: ESA1RR - Welsh PDF, 376KB, 28 pages

This file may not be suitable for users of assistive technology. Request an accessible format.

Welsh: Ffurflen hawlio adnewyddu Lwfans Cyflogaeth a Chymorth: Dylech dim ond llenwi’r ffurflen hon os cawsoch Lwfans Cyflogaeth a Chymorth yn ystod y 12 wythnos diwethaf: argraffu

Ref: ESARR - Welsh - print PDF, 176KB, 28 pages

This file may not be suitable for users of assistive technology. Request an accessible format.

Details

You may not have to fill in this form. The quickest way to apply for ESA is by phone.

You may be able to apply for Universal Credit. Check you’re eligible for ESA before you apply.

Where to send your form

Send the completed form to your Jobcentre Plus office.

Published 1 April 2013
Last updated 30 November 2018 + show all updates

IRRV Alert - week ending 30th November 2018

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Employment and Support Allowance claim form

Employment and Support Allowance claim form

Documents

This file may not be suitable for users of assistive technology. Request an accessible format.

This file may not be suitable for users of assistive technology. Request an accessible format.

This file may not be suitable for users of assistive technology. Request an accessible format.

This file may not be suitable for users of assistive technology. Request an accessible format.

This file may not be suitable for users of assistive technology. Request an accessible format.

Details

Where to send your form

IRRV Software